P1082: SAFETY AND EFFICACY ANALYSIS IN OLDER PATIENTS TREATED WITHIN THE GATLA LH-05 PROTOCOL: PET-ADAPTED THERAPY AFTER 3 CYCLES OF ABVD FOR ALL STAGES OF HODGKIN LYMPHOMA
Authors: N. L. Fiad, M. V. Prates, I. Fernandez, N. Kurgansky, A. Cerutti, F. Negri Aranguren, L. Guanchiale, F. Sackmann, J. Maradei, A. Enrico, P. Negri Aranguren, A. Pavlovsky
Journal: HemaSphere (2022)

Background: Treatment for classic Hodgkin lymphoma (cHL) in older age population continues to be a challenge. Comorbidity prevalence, increase toxicity to the standard treatments and the lack of inclusion in clinical trials all contribute to this phenomenon. The obtained results are inferior in comparison to young adults and there is shortage of evidence regarding effective therapeutic strategies. Recently, the GATLA LH-05 protocol has published the long-term follow-up of the results of the PET/CT adapted strategy after 3 cycles of ABVD, regardless of the presentation stage and no upper age limit. Aims: To assess the effectiveness and safety of the interim PET/CT adapted treatment in cHL patients older than 60 years old. Methods: A retrospective analysis of the LH-05 database was performed. Patients were included ≥ aged 60 with recent diagnosis of cHL stage I-IV and HIV negative. All patients received 3 cycles of ABVD and were evaluated with PET-TC (PET3). Those patients with negative PET (Deauville score 1 and 2) were considered to be in complete remission (CR) and they finalized the treatment. Patients with DS 3 and 4 completed 6 ABVD cycles and involved-field radiotherapy in hypermetabolic areas in interim PET3. Patients with DS 5 were considered to have progressive disease. Progression-free survival (PFS) and overall survival (OS) were evaluated. Kaplan-Meier method and Log-rank test were used for survival analysis. Results: Of a total of 490 patients included in the GATLA LH-05 protocol, 59 met the inclusion criteria. The mean age was of 66 years (range: 60-89), 90% presented a PS<2. The most frequent histological subtype was Nodular Sclerosis (54%) and 75% presented in localized stage (I-II). All patients received initial treatment with 3 cycles of ABVD and were evaluated by PET: 81% presented negative PET (DS 1-2) and 19% were positive. No GIII-IV toxicity or treatment-related deaths were recorded. With a median follow-up of 10 years, median PFS and OS were not reached. At 36 and 60 months, PFS was 86% and 78,9%, and OS was 90% and 85.5%, respectively. Negative PET3 patients had a PFS of 85.4%, while positive PET3 patients had a PFS of 43% (p=0,0001). In the multivariable analysis that included age (>60 vs. <60), stage (localized vs. advanced), IPS (<2 vs. >2), extranodal areas, bulky disease and PET3 result, only age and PET3 result had significant impact in PFS (p=0.046 and p=0,001 respectively). PFS of PET/TC- positive patients was significantly lower than in the cohort of patients younger than 60. OS at 36 and 60 months in PET negative patients was 97.5% and 94.5% respectively, versus 63.6% and 53% in PET/TC positive patients. Image:Summary/Conclusion: With the PET/TC adapted treatment after 3 cycles of ABVD in 59 patients > 60 years old, 81% of patients achieved negative PET and therefore received no further treatment. These patients had an excellent result with a PFS of 85.4% at 3 years, similar to the younger patient population. However, a significant reduction in PFS was observed in PET3 positive patients > 60 years old compared to younger ones. Implementation of this PET/TC guided strategy, regardless of stage at diagnosis, resulted in reduced exposure to chemotherapy and radiotherapy, contributing to the absence of severe treatment-related morbidity and mortality.